Gelfand Dmitri V, Podnos Yale D, Carmichael Joseph C, Saltzman Darin J, Wilson Samuel E, Williams Russell A
Department of Surgery, University of California, Irvine, Irvine Medical Center, Orange 92868, USA.
Arch Surg. 2004 Sep;139(9):933-8; discussion 938-40. doi: 10.1001/archsurg.139.9.933.
With the introduction of the newly mandated restrictions on resident work hours, we expected improvement in subjective feelings of personal accomplishment and lessened emotional exhaustion and depersonalization.
Residents and faculty members completed an anonymous online Maslach Burnout Inventory Human Services Survey (3rd ed; Consulting Psychologist Press Inc, Palo Alto, Calif) and work-hour registry before and after implementation of new restrictions.
Urban, university-based department of surgery.
All house staff (n = 37) and faculty (n = 27).
Introduction of new Institutional Standards for Resident Duty Hours 2003. Main Outcome Measure Resident work hours and levels of emotional exhaustion, perceived degree of depersonalization, and personal accomplishment.
Resident work hours per week decreased from 100.7 to 82.6 (P < .05) with introduction of the new schedule. Home call and formal educational activity time within working hours (eg, clinical conferences) significantly (P < .05) decreased from 11.5 and 4.8 hours to 4.6 and 2.5 hours per week, respectively. Operating room hours, clinic time, and duration of rounds did not show a significant change. Changes in parameters of resident and faculty emotional exhaustion, depersonalization, and personal accomplishment did not show statistical significance (P > .05).
Despite successful reductions in resident work hours, measures of burnout were not significantly affected. However, important clinical activities such as time spent in the operating room, clinic, and making rounds were maintained. Formal in-hospital education time was reduced.
随着新规定的住院医师工作时长限制的引入,我们预期个人成就感的主观感受会得到改善,情感耗竭和去个性化程度会降低。
在新限制实施前后,住院医师和教职员工完成了一份匿名的在线马氏职业倦怠量表(人类服务版,第3版;咨询心理学家出版社,加利福尼亚州帕洛阿尔托)和工作时长登记。
城市中以大学为基础的外科系。
所有住院医师(n = 37)和教职员工(n = 27)。
引入2003年新的住院医师值班时长机构标准。主要观察指标:住院医师工作时长以及情感耗竭水平、去个性化感知程度和个人成就感。
随着新排班的引入,住院医师每周工作时长从100.7小时降至82.6小时(P < 0.05)。工作时间内的家中值班时间和正式教育活动时间(如临床会议)分别从每周11.5小时和每周4.8小时显著(P < 0.05)降至每周4.6小时和2.5小时。手术室工作时间、门诊时间和查房时长没有显著变化。住院医师和教职员工的情感耗竭、去个性化和个人成就感参数变化没有统计学意义(P > 0.05)。
尽管成功减少了住院医师的工作时长,但职业倦怠指标并未受到显著影响。然而,重要的临床活动,如在手术室、门诊和查房所花费的时间得以维持。医院内的正式教育时间减少了。